PDF(Pubmed)
Abstract：
In the intensive care unit, it can be challenging to determine which interventions align with the patients\' preferences since patients are often incapacitated and other sources, such as advance directives and surrogate input, are integral. Managing treatment decisions in this context requires a process of shared decision-making and a keen awareness of the preference-sensitive instances over the course of treatment. The present paper examines the need for the development of preference-sensitive decision timelines, and, taking aneurysmal subarachnoid hemorrhage as a use case, proposes a model of one such timeline to illustrate their potential form and value. First, the paper draws on an overview of relevant literature to demonstrate the need for better guidance to (a) aid clinicians in determining when to elicit patient preference, (b) support the drafting of advance directives, and (c) prepare surrogates for their role representing the will of an incapacitated patient in clinical decision-making. This first section emphasizes that highlighting when patient (or surrogate) input is necessary can contribute valuably to shared decision-making, especially in the context of intensive care, and can support advance care planning. As an illustration, the paper offers a model preference-sensitive decision timeline-whose generation was informed by existing guidelines and a series of interviews with patients, surrogates, and neuro-intensive care clinicians-for a use case of aneurysmal subarachnoid hemorrhage. In the last section, the paper offers reflections on how such timelines could be integrated into digital tools to aid shared decision-making.
摘要：
在重症监护室，确定哪些干预措施符合患者的偏好可能是具有挑战性的，因为患者通常是无行为能力的和其他来源的，如预先指令和代理输入，是积分。在这种情况下管理治疗决策需要一个共同决策的过程，并在治疗过程中对偏好敏感的实例有敏锐的认识。本文研究了制定偏好敏感决策时间表的必要性，and,以动脉瘤性蛛网膜下腔出血为用例，提出了一个这样的时间表的模型来说明它们的潜在形式和价值。首先,本文借鉴了相关文献的概述，以证明需要更好的指导，以（a）帮助临床医生确定何时引起患者的偏好，(b)支持起草预先指示，和(c)准备代表无行为能力患者在临床决策中的意愿的代理人。这第一部分强调，当病人（或代理人）输入是必要的突出可以有价值地促进共同的决策，特别是在重症监护的背景下，并可以支持提前护理计划。作为一个例证,该论文提供了一个模型偏好敏感的决策时间表，其生成是由现有指南和一系列患者访谈提供的，代理人,和神经重症监护临床医生-用于动脉瘤性蛛网膜下腔出血的案例。在最后一节,本文对如何将这些时间表整合到数字工具中以帮助共享决策提供了思考。
